In the United States, trauma is the leading cause of death among patients between the ages of 1 and 44 years of age and the third leading cause of death overall. Approximately 20 to 40% of trauma deaths occur after hospital admission and are a result of massive hemorrhage. There have been no large, multi-center, randomized clinical trials with survival as a primary end point that support optimal trauma resuscitation practices with approved blood products and therefore there are many conflicting recommendations. The Prosective Observational Multicenter Major Trauma Transfusion (PROMMT) Trial demonstrated that many clinicians were transfusing patients with blood products in a ratio of 1:1:1 or 1:1:2 and that early transfusion of plasma was associated with improved 6-hour survival after admission.

This study was appropriately powered to detect a 10% difference in mortality between the 1:1:1 and 1:1:2 groups, however the study could not definitively establish a benefit < 10%

Physicians not blinded once transfusion protocol begun

Unable to completely exclude patients with an unsurvivable brain injury (23% of deaths at 24 hrs and 38% of deaths at 30 days)

Study Conclusion: Among patients with severe trauma and major bleeding, early administration of plasma, platelets, and red blood cells in a 1:1:1 ratio vs 1:1:2 ratio did not result in significant differences in mortality at 24 hours or 30 days. However, more patients in the 1:1:1 group achieved hemostasis and fewer experienced death due to exsanguination at 24 hours.

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Ultimately, this was an underpowered study to determine < 10% mortality benefit at 24 hours and 30 days, however the 1:1:1 transfusion strategy decreases death from exsanguination at 24 hours, achieves more rapid hemostasis, and has no additional complications associated with it.

[…] the effect of 1:1:1 (adding platelets as the third blood product) to vs. 1.5:1:1 – check out Salim’s awesome review . Although there was no difference in over-all mortality at 24 hours and 30 days, death from […]